Critical care after lung resection: CALoR 1, a single‐centre pilot study

McCall, Pamela; Macfie, Alistair; Kinsella, John; Shelley, Ben

doi:10.1111/anae.13267

Cited by 23 publications

(13 citation statements)

References 25 publications

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“…To the best of our knowledge, this is the first study to describe an ultrasound‐guided supraclavicular phrenic nerve block for the treatment of postoperative ipsilateral shoulder pain. Pulmonary resections are increasingly frequent in the UK and we believe this treatment could be an important way to treat postoperative ipsilateral shoulder pain, which is common and has been proven difficult to relieve pharmacologically . Other nerve blocks such as suprascapular or interscalene brachial plexus blocks have been used previously, but these were only partly effective and both produce a full motor block of the shoulder muscles .…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

et al. 2016

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Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery.

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Section: Discussionmentioning

confidence: 99%

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

et al. 2016

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“…Following a successful single‐centre pilot study , we decided to undertake a multicentre retrospective study, coordinated by the Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) to examine unplanned ICU admission following lung resection over a period of two years. The study had three main aims.…”

Section: Introductionmentioning

confidence: 99%

Association between anaesthetic technique and unplanned admission to intensive care after thoracic lung resection surgery: the second Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) National Audit

et al. 2019

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Unplanned intensive care admission is a devastating complication of lung resection and is associated with significantly increased mortality. We carried out a two-year retrospective national multicentre cohort study to investigate the influence of anaesthetic and analgesic technique on the need for unplanned postoperative intensive care admission. All patients undergoing lung resection surgery in 16 thoracic surgical centres in the UK in the calendar years 2013 and 2014 were included. We defined critical care admission as the unplanned need for either tracheal intubation and mechanical ventilation or renal replacement therapy, and sought an association between mode of anaesthesia (total intravenous anaesthesia vs. volatile) and analgesic technique (epidural vs. paravertebral) and need for intensive care admission. A total of 253 out of 11,208 patients undergoing lung resection in the study period had an unplanned admission to intensive care in the postoperative period, giving an incidence of intensive care unit admission of 2.3% (95%CI 2.0-2.6%). Patients who had an unplanned admission to intensive care unit had a higher mortality (29.00% vs. 0.03%, p < 0.001), and hospital length of stay was increased (26 vs. 6 days, p < 0.001). Across univariate, complete case and multiple imputation (multivariate) models, there was a strong and significant effect of both anaesthetic and analgesic technique on the need for intensive care admission. Patients receiving total intravenous anaesthesia (OR 0.50 (95%CI 0.34-0.70)), and patients receiving epidural analgesia (OR 0.56 (95%CI 0.41-0.78)) were less likely to have an unplanned admission to intensive care after thoracic surgery. This large retrospective study suggests a significant effect of both anaesthetic and analgesic technique on outcome in patients undergoing lung resection. We must emphasise that the observed association does not directly imply causation, and suggest that well-conducted, large-scale randomised controlled trials are required to address these fundamental questions.

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“…The use of LA techniques in thoracic anaesthesia is well established for both open thoracotomy and VATS procedures, and while no strong evidence exists over the ideal technique to use, it can be said that both TEA and PVB are "gold-standard" techniques and while PVB are associated with fewer minor side effects, there is no association with either technique and serious complications (36). They can provide excellent analgesia in the postoperative period and are essential to the idea of ERAS, with their ability to provide analgesia for patients to mobilise as early as possible and reduce consumption of opioids.…”

Section: Discussionmentioning

confidence: 99%

The role of local anaesthetic techniques in ERAS protocols for thoracic surgery

Crumley

Schraag

2018

J. Thorac. Dis.

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The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential.

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Critical care after lung resection: CALoR 1, a single‐centre pilot study

Cited by 23 publications

References 25 publications

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

Association between anaesthetic technique and unplanned admission to intensive care after thoracic lung resection surgery: the second Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) National Audit

The role of local anaesthetic techniques in ERAS protocols for thoracic surgery

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